What are the contraindications for the varicella (chickenpox) vaccine?

Contraindications for Varicella (Chickenpox) Vaccine

The varicella vaccine is contraindicated in individuals with history of anaphylactic reaction to vaccine components, immunodeficiency conditions, pregnancy, and those on high-dose systemic immunosuppressive therapy. 1

Absolute Contraindications

Allergy to Vaccine Components

• Contraindicated in persons with history of anaphylactic reaction to any vaccine component, including gelatin 1
• Contraindicated in those with history of anaphylactic reaction to neomycin 1
• Note: Contact dermatitis to neomycin is NOT a contraindication 1
• For MMRV vaccine specifically, skin testing is not required before administration to persons with egg allergy 1

Immunodeficiency Conditions

• Contraindicated in persons with malignant conditions affecting bone marrow or lymphatic systems (blood dyscrasias, leukemia, lymphomas) 1
• Contraindicated in persons with primary or acquired immunodeficiency, including:
  • AIDS or other clinical manifestations of HIV infections (with exceptions noted below) 1, 2
  • Cellular immunodeficiencies 1
  • Hypogammaglobulinemia and dysgammaglobulinemia 1
• Contraindicated in persons with family history of congenital/hereditary immunodeficiency in first-degree relatives unless immune competence has been verified 1

Immunosuppressive Therapy

• Contraindicated in persons receiving high-dose systemic immunosuppressive therapy:
  • Oral steroids >2 mg/kg/day of prednisone or equivalent
  • Total of >20 mg/day of prednisone for persons weighing >10 kg
  • When administered for >2 weeks 1
• Note: This contraindication does NOT apply to persons receiving:
  • Inhaled, nasal, or topical corticosteroids
  • Low-dose corticosteroids for asthma prophylaxis
  • Corticosteroid-replacement therapy 1

Pregnancy

• Contraindicated in pregnant women due to unknown effects on fetal development 1
• Non-pregnant women should avoid pregnancy for 1 month after each dose 1
• Note: Having a pregnant household member is NOT a contraindication for vaccinating other household members 1

Special Considerations

HIV Infection

• Varicella vaccine may be considered for HIV-infected children in CDC class 1 with CD4+ T-lymphocyte percentage ≥15% 1, 3
• Only monovalent varicella vaccine (not MMRV) should be used in these cases 1, 4
• Close monitoring is required, and expert consultation is advised 1

Acute Illness

• Vaccination should be postponed in persons with acute severe illness, including untreated active tuberculosis 1
• The decision to delay vaccination depends on severity of symptoms and etiology of disease 1

Potential Consequences of Inappropriate Administration

• Immunocompromised individuals may develop more extensive vaccine-associated rash or disseminated disease 1, 5
• Severe varicella infection by vaccine strain has been documented in immunocompromised patients 6, 5
• Kidney transplant recipients have experienced disseminated vaccine-induced varicella infection requiring prolonged hospitalization 5

Clinical Pitfalls to Avoid

• Do not administer MMRV vaccine as a substitute for component vaccines when vaccinating HIV-infected children 1
• Do not assume that all corticosteroid therapy is a contraindication - only high-dose systemic therapy as defined above 1
• Do not overlook family history of immunodeficiency, which requires verification of immune competence before vaccination 1
• Ensure adequate provisions for treating anaphylactic reactions are available when administering the vaccine 1